College-Bound Californians Navigate Abortion Bans Away From Home

When I’laysia Vital got accepted to Texas Southern University, a historically Black university, she immediately began daydreaming about the sense of freedom that would come with living on her own, and the sense of belonging she would feel studying in a thriving Black community.

But when a nurse at her high school health clinic in California explained the legal landscape of her new four-year home in Texas — where abortion is now banned completely — and Vital started watching videos on TikTok of protestors harassing women outside clinics in the South, she realized her newfound freedoms would come at the expense of another. That’s when she added one more task to her back-to-school checklist: get a long-acting, reliable birth control before leaving California.

“I don’t want to go out there and not know anything, not know where to go, because I’m in a new state. So I’m trying to be as prepared as I can before I leave,” she said.

The change is a huge culture shock for Vital and her classmates, who, for the last four years at Oakland Technical High School, have had access to their own health clinic on campus. The “TechniClinic” is a bright purple building across from the football field and bleachers, complete with the school’s bulldog mascot painted by the front door, where students can get free, confidential birth control consults and STI checks, then be back at their desks for fourth-period math.

This summer, nurses at Oakland Tech’s Clinic have institutionalized the “senior sendoff” appointment, where they counsel students as much about their legal rights as their medical options before they leave for college. After Roe v. Wade was overturned last year, staff realized students of color would be disproportionately impacted by changes in state abortion laws. Many of them are like Vital who are choosing to go to historically Black colleges and universities in Southern states where bans and limits on the procedure are more common.

“Many students here are just totally floored when I tell them that these laws are different in the states that they’re going to,” said Arin Kramer, a family nurse practitioner at Oakland Tech’s Clinic. “They can’t believe that they can’t get an abortion in this country.”

Kramer has been writing prescriptions for a year’s worth of pills or patches, which under California law, students can get for free, all at once, without having to tell their parents or use their parents’ insurance plan. Students can pick up the prescription at the clinic, or Kramer will call it in to a pharmacy near the student’s home.

But during her own senior sendoff appointment, Vital told Nurse Kramer that she was in the market for something even more reliable than pills.

“Because I’m very forgetful. Even if I set an alarm or write it down, it will still slip my mind,” Vital said.

She wanted a long-term contraceptive, like an IUD or an implant that would last for years and require no upkeep. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics have made these options their top recommendation for adolescents, after research from both groups showed they were safe and highly effective at preventing teen pregnancy. So at Oakland Tech and other school-based health clinics run by the nonprofit La Clinica de la Raza, Kramer has trained other nurse practitioners how to insert these devices so students can get them the same day they ask for them.

These are the kinds of clinical protocols university-based health centers are now considering in the wake of the Supreme Court ruling overturning Roe. In 2020, only 35% of colleges offered on-site IUD insertion and 43% offered contraceptive implant insertion, according to a survey (PDF) by the American College Health Association.

That group now also recommends (PDF) college clinics do routine pregnancy screening to identify pregnancies as early as possible, to give students more time to consider their options, and to have legal counsel on-call to advise clinicians on allowable practices and even conversations with patients, especially in states like Texas, where local law forbids clinicians from “aiding and abetting” patients who seek abortion care. The new threat of prosecution or pulled funding has thrown clinicians’ communication with their patients into awkward contortions.

“So I’m going to be vague with my wording, purposefully,” said Yolanda Nicholson, director of clinical education at the North Carolina Agricultural and Technical State University health center and chair for the coalition of Historically Black Colleges and Universities of the American College Health Association.

Nicholson thinks the concept of the senior sendoff appointment is a great one, as college health centers in Texas and throughout the South have had to adjust their educational approach with students to be more general and “maybe not as specific or targeted as we would have previously done,” to stay aligned with local laws. Out-of-state students are often shocked to discover they don’t have access to the same services as they do at home.

At Oakland Tech’s clinic, when I’laysia Vital decided she wanted a contraceptive implant, Kramer went over her options in clear, unmitigated terms, even dropping in phrases students themselves use in the cafeteria amidst her health screening questions around sleep and mood.

“Who are you talking to these days?” Kramer asked Vital, adolescent-speak for: Who are you having sex with?

“Same person,” Vital replied.

“You guys have been off and on, off and on,” Kramer said. “How do you feel going forward?”

“Well, now they’re on because he’s going to Texas, too,” Vital revealed with a smile. “He’s going with me.”

So the clinic staff started preparing the exam room to place the implant right away. Kramer turned on some calming music on her phone, washed her hands and had Vital lie down and raise her left hand over her head. Physician assistant Andrea Marquez came in to hold Vital’s other hand and offer words of encouragement.

“I’m going to count to three and then you’ll feel a little pinch,” Kramer said, as she gave Vital a shot of numbing medication in her tricep. Then she coached her through a series of deep breaths before inserting the tiny rod under her skin.

The whole procedure took less than ten minutes. And Vital walked out with a birth control method that will last her up to five years. Now she says she can focus on her education and fully experience the new freedoms of college.

“I’m really excited for the growing up part of it,” she said.